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Biol Blood Marrow Transplant. 2018 Nov;24(11):2265-2270. doi: 10.1016/j.bbmt.2018.07.019. Epub 2018 Jul 19.

Outcomes of Advanced Hodgkin Lymphoma after Umbilical Cord Blood Transplantation: A Eurocord and EBMT Lymphoma and Cellular Therapy & Immunobiology Working Party Study.

Author information

1
Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco.
2
Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco; Department of Haematology, Hospital Sao Paulo, San Paulo, Brazil.
3
Service d'Hématologie, CHU Lapeyronie, Montpellier, France.
4
Service d'Hématologie et Thérapie Cellulaire, Hôpital Haut-leveque, CHU Bordeaux, Pessac, France.
5
Clinical Hematology Service, Hospital de la Santa Creu i Sant Pau, Jose Carreras Leukaemia Research Institute, Barcelona, Spain.
6
Service d'hématologie, Hotel Dieu, Nantes, France.
7
Service d'Hématologie et thérapie cellulaire, Institute Paoli Calmettes, Marseille, France.
8
Institut d'Hématologie de Basse-Normandie, Caen, France.
9
Hematologie Clinique, Hopital la Pitié-Salpêtrière, Paris, France.
10
Hématologie Clinique, CHU Grenoble Alpes, Grenoble, France.
11
BMT Unit, Institute Portugues Oncologia, Lisbon, Portugal.
12
Department of Hematology and BMT, Rambam Medical Center, Haifa, Israel.
13
Department of Internal Medicine, Hematology and Oncology, University Hospital Maastricht, Maastricht, Netherlands.
14
Department of Hematology Adult Stem Cell Transplantation Unit, Ankara University, Ankara, Turkey.
15
Service d'Hematologie et Therapie Cellulaire, Hôpitaux des Brabois, Nancy, France.
16
Department of Hematology, CHU of Liège and University of Liege, Liege, Belgium.
17
Hematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Centro de Investigacion del Cancer-IBMCC, Salamanca, Spain.
18
Department of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
19
Department of Haematology, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom.
20
Stem Cell Transplant Unit Medical Park Hospitals, Antalya, Turkey.
21
Division of Hematology, Az. Ospedaliera S. Croce e Carle, Cuneo, Italy.
22
Institute of Hematology, "Seragnoli" University Hospital S. Orsola-Malpighi, Bologna, Italy.
23
Bristol Oncology Centre, EBMT Lymphoma Working Party, Bristol, United Kingdom.
24
Department of Haemato-Oncology, St. Bartholomew's Hospital, Barts Health NHS Trust, EBMT Lymphoma Working Party, London, United Kingdom.
25
Eurocord, Hôpital Saint Louis, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco; Hematology Department, Ospedale Pediatrico Bambin Gesù, Dipartimento di Oncoematologia e Terapia Cellulare e Genica, Rome, Italy. Electronic address: annalisaruggeri80@hotmail.com.

Abstract

Allogeneic stem cell transplantation is an alternative for patients with relapsed or refractory Hodgkin lymphoma (HL), but only limited data on unrelated umbilical cord blood transplantation (UCBT) are available. We analyzed 131 adults with HL who underwent UCBT in European Society for Blood and Marrow Transplantation centers from 2003 to 2015. Disease status at UCBT was complete remission (CR) in 59 patients (47%), and almost all patients had received a previous autologous stem cell transplantation. The 4-year progression-free survival (PFS) and overall survival (OS) were 26% (95% confidence interval [CI], 19% to 34%) and 46% (95% CI, 37% to 55%), respectively. Relapse incidence was 44% (95% CI, 36% to 54%), and nonrelapse mortality (NRM) was 31% (95% CI, 23% to 40%) at 4 years. In multivariate analysis refractory/relapsed disease status at UCBT was associated with increased relapse incidence (hazard ratio [HR], 3.14 [95% CI, 1.41 to 7.00], P = .005) and NRM (HR, 3.61 [95% CI, 1.58 to 8.27], P = .002) and lower PFS (HR, 3.45 [95% CI, 1.95 to 6.10], P < .001) and OS (HR, 3.10 [95% CI, 1.60 to 5.99], P = .001). Conditioning regimen with cyclophosphamide + fludarabine + 2 Gy total body irradiation (Cy+Flu+2GyTBI) was associated with decreased risk of NRM (HR, .26 [95% CI, .10 to .64], P = .004). Moreover, Cy+Flu+2GyTBI conditioning regimen was associated with a better OS (HR, .25 [95% CI, .12 to .50], P < .001) and PFS (HR, .51 [95% CI, .27 to .96], P = .04). UCBT is feasible in heavily pretreated patients with HL. The reduced-intensity conditioning regimen with Cy+Flu+2GyTBI is associated with a better OS and NRM. However, outcomes are poor in patients not in CR at UCBT.

KEYWORDS:

Adult patients; Hodgkin lymphoma; Umbilical cord blood transplantation

PMID:
30031070
DOI:
10.1016/j.bbmt.2018.07.019

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